H E A L T H A N D ...

HEALTH AND STRESS
T h e Ne w s l e t t e r of
The Ameri can In stitut e of S tress
January
2007
STRESS SCOOPS TO KEEP YOU
AU COURANT & AIS AT THE TOP
KEYWORDS: G o o g l e r a n k i n g s , s e a r c h e n g i n e o p t i m i z a t i o n , e x e r c i s e a n d s t r e s s r e d u c t i o n , c e l l
p h o n es a n d stress, la u g h ter' s h ea lth b en efi ts, stress r ed u ctio n a n d lo n g evity r ew a rd s o f h a p p y
m a rria g es, m a rita l sp a ts a n d si ckn ess, n ew sa liva ry str ess m ea su rem en t, stress a n d
a b d o m in a l o b esity, stress red u c tio n lo w ers a n d a n xiety in crea ses ri sk o f recu rr en t h ea rt a t ta ck
Our website www.stress.org has enjoyed the #1 ranking for "stress" and "job stress"
inquiries on Google and most other major search engines for sev eral years. Being Numero
Uno on Google means that the Am erican I nstitut e of St ress is at t he top of a list of
some 32 m illion ot her sites competing to attract viewers interested in "st ress." I
never really appreciated how important this was until a few years ago, when I learned how
numerous companies and indiv iduals made a pretty good liv ing just by increasing the
ratings of specific search terms for their clients so they can appear in the top 20 or 30
listings. Google lists ten sites per page and since web surfers usually lose interest after a
few pages, this can be crucial if you want to reach a large audience. It's not clear how we
were able to achieve, much less maintain, our enviable #1 position for so long since we had
no outside help with respect to the design or any other aspect of our site. Others who are
knowledgeable about such matters believe it is because we have so much relev ant and up to
date content for these specific key words.
However, we also have a great deal of
authoritative material that is constantly updated: stress and heart disease, stress and
obesity, stress and cancer, stress reduction, heart rate variability, etc. – all of which had
disappointing ratings. This was particularly puzz ling since a thorough review revealed we
obviously had much more comprehensive and superior coverage than many sites that
rank ed in the top 20, two or more pages ahead of us.
Equally confusing was the fact that although we had the top rank ing for job stress, we
could be significantly lower for searches on "occupational stress", "stress at work ",
"work place stress" and other synony ms. This was simply because these specific key words
did not appear in the tex t. I subsequently learned that rank ings are determined by a
complex formula that not only searches for the frequency of such specific terms but also
whether and where they appear on the home page, are positioned at the beginning of a
paragraph, are in upper case or bolded, etc. Google and possibly other search engines can
also determine whether the terms are included in tex t that is appropriate rather than
simply being repeated sev eral times in a meaningless fashion solely designed to increase
ratings. Indeed, engaging in this or other some other subterfuge could actually back fire
and significantly lower the rank ing for that term. How many link s there are to and from
other sites are important but Google filters out those from known "link farms" that ex ist
January 2007
The Newsletter of THE AMERICAN INSTITUTE OF STRESS
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simply to boost ratings. While you cannot control link s that come from such sites you may
also be penalized if you prov ide a link to a site that is obv iously bogus.
The criteria for determining ratings varies with different search engines and the priorities
for each of these can also change ev ery few week s or months. If you go to Google and
ty pe in "How can I increase my Google rating?" (position, listing, page rank ing or
something similar), you will instantly receive a list of sev eral million sites as well as
sponsored link s to companies, book s and consultants who can prov ide assistance.
Howev er, since the criteria and algorithms for determining rankings are constantly
changing some adv ice is obsolete and many more will be out of date in the near future.
Various vendors each claim to know trick s of the trade that others are unaware of that are
guaranteed to increase traffic to your site. These include alerting search engines that their
robots need to visit a site promptly to keep up with important new advances or some other
secret based on "inside information". It is impossible to keep up with all these changes
and pay ing someone else to do it is not lik ely be very cost effectiv e. Consequently ,
continual monitoring is crucial to assess any changes in status and to achiev e and maintain
a high rank ing for the key words you are particularly interested in. Hav ing spent the past
1 2 months doing this, I am conv inced that the most efficient way to insure that key words
will rank as high as possible is by constantly adding new material that not only includes
these terms but is crafted so that it emphasiz es their importance in a meaningful fashion.
The robots or spiders that search engines send out to collect and collate data are becoming
increasingly sophisticated and how often a key word appears no longer has the same
weight in determining rank ings. Appropriate synonyms are increasingly being factored in
since it is clear that many viewers may not select the most appropriate search terms to
find ex actly what they are look ing for. The bottom line is that your chances of rising to
the top of the rank ings list for any search term is most lik ely to depend on how much
content is dev oted to it as well as how comprehensiv e and current this cov erage is.
Bearing this in mind, we recently introduced a new serv ice called "Stress Scoops" to
prov ide week ly or more frequent summaries of recent adv ances and dev elopments in the
field of stress. Most of these will consist of two or three paragraphs with references to
assist those who want additional information. There will be occasional longer "Stress
Bulletins" that include commentary ex plaining why this contribution could be important or
how it differs from prior findings
This new feature will help boost our ratings for those
k eywords that deserv e this boost by allowing us to focus on topics that need to be
emphasiz ed based on feedback from our surv eillance activ ities. Stress Scoops could also
improv e our ability to attract sponsors with pertinent products or serv ices. We hav e nev er
accepted any advertisements in an effort to maintain our standards for impartiality since
such sponsorship might imply an unwarranted endorsement. However, there are some
products that we can and should recommend based on scientific studies that could be
reported on or referenced in a Stress Scoop if appropriate. Other products may also have
merit because of impressiv e anecdotal evidence that consumers need to be informed
about. In all instances, sponsors will be clearly identified, any health or other claims must
be substantiated and all advertisements must be approv ed to insure that they are
compatible with our educational mission and not misleading.
These frequent Stress Scoop releases will also provide a rich resource for viewers who
want to keep up to date on the latest stress research findings and learn about new
products and serv ices. All visitors will be able to see the current Stress Scoop in its
entirety as well as the titles and ex cerpts of previous ones but only AIS Members and
Fellows hav e access to the complete contents of all Stress Scoops. In addition to the latest
addition, visitors may also register to view the entire contents of six prev ious Stress
Scoops at no charge to obtain a better idea of what different types look lik e, such as the
following ex amples.
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WHY DOES EXERCI SE REDUCE ST RESS A ND HOW MUCH DO YOU NEED?
"It's clear that exercise is beneficial for mental health. What's not clear is how it works."
according to the Editor-in-Chief of the Harvard Health letter. In one study, researchers
reported that clinically depressed adults who participated in regular exercise for three months
had an improvement in symptoms similar to what might have been achieved with
antidepressant drugs. Other studies have found that higher levels of physical activity are
associated with fewer symptoms of depression in children as well as improvement in
symptoms of adults with PTSD, panic and other anxiety disorders.
Possible explanations are that vigorous exercise can increase levels of endorphins, which are
known to provide a sense of well-being and increased resistance to pain. Elite marathoners
may experience a feeling of euphoria referred to as the "runner's high" and are often so
insensitive to pain that they continue to run on broken bones that would normally bring them
to an immediate halt. However, the old adage "no pain, no gain" no longer seems to be valid
since many stress reduction rewards can be achieved by walking for 20-30 minutes several
times a week or other much milder physical activities that promote a sense of well being. The
support provided by others in group exercise activities as well as an improved sense of
self–esteem associated with physical activity can also have powerful stress reduction effects.
Some people who are depressed or anxious may not have any desire
to exercise but should be encouraged to do as much as they can,
even if it's just a few minutes at a time. The reason is that this
often leads them to increase their activities bit by bit as they
experience more benefits. According to the Harvard Mental Health
Letter, "You don't have to have a program that includes 45 minutes
of sweating and grunting and moaning . . . . A 10-minute walk is as
good a place to start as anything else."
Rats who were allowed to exercise as much as they wanted to on a
free running wheel showed less severe and fewer "fight or flight"
responses to a painful stressor compared to litter mates in similar
cages with a fixed wheel. The exercise group had lower levels of
stress related hormones and reduced sympathetic nervous system
responses that may explain these findings. Regular exercise has also been shown to improve
cardiovascular and immune system function.
References: Harvard Mental Health Letter, December 2005, Bartholomew JB, et al. Effects of Acute
Exercise on Mood and Well-Being in Patients with Major Depressive Disorder. Med Sci Sports Exerc.
2005;37:2032-2037. Fleshner M. Physical Activity Reduces the Negative Effects of Stress on Behavior,
Neural, Endocrine and Immune Responses: Med Sci Sports Exerc. May, 2005; 37(5),.
Supplement:S134 Health And Stress Newsletter #1, #12, 1994 and # 4, 2005.
ARE CELL PHONES INCRE ASING STRESS LEVEL S?
One might think that having a cell phone would tend to reduce stress by making it easier to
quickly contact someone in an emergency and providing a sense of safety and control.
However, a recent study suggests otherwise. A sociology professor who followed more than
1300 people found that those who regularly used cell phones or pagers "experienced an
increase in psychological distress and a decrease in family satisfaction" compared to controls
who used these devices less often. No increase in psychological stress was seen in others
who regularly used e-mails to communicate.
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The study also looked at "spillover" -- the seepage of job stress problems into home life, and
vice versa. Increased cell phone use was associated with a greater likelihood for job stress to
adversely affect family relationships for both men and women. Female cell phone users got a
"double-whammy" since they were much more apt to report home and family concerns that
spilled over into work. While it's dangerous to draw general conclusions from one study,
others also feel that cell phones and pagers are somehow increasing psychological stress and
decreasing family satisfaction for many individuals.
One reason may be that, although cell phones may make people more accessible wherever
they are, this may not be desirable for unwanted calls when you are on vacation or busy at
work. In addition, as use of cell phones and pagers becomes increasingly prevalent, the line
between family and work life can continue to blur. The professor suggests that consumers
might want to evaluate the pros and cons, if cell phones are "making your family better, even
if it's stressing you out . . . . Then, maybe it's OK. Or maybe you should take stock: How
much of this information that I'm getting from this technology is making my life easier? If the
answer is, 'Not a lot,' maybe it's time to shut things down."
Reference: Chesley, N. Journal of Marriage and Family 2005; 67:1237-1248.
LAU GHTER LOWERS STRES S, HEL PS YOU R HEAR T, LEN GTHENS LIFE AND
PRO VIDES OTHER PERKS
The stress reduction and health rewards of
laughter have long been recognized. The Bible
tells us "A merry heart doeth good like a
medicine" (Proverbs 17:22) and laughter might
also be the best medicine for your heart according
to a recent study.
Researchers randomly
assigned 20 non-smoking, healthy men and
women to view a 15–30 minute segment of a
movie designed to induce mental stress and
another that made most people laugh. Numerous
measurements of arterial blood flow using an
ultrasound technique were made prior to and for
an hoiur following the viewing of each film. Blood
flow was restricted in 14 of 20 subjects after the stressful film but increased in 19 of 20 after
the film that made them laugh. The average difference between these two responses was
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greater than 50 percent. The reduction in blood flow after the sad film was equivalent
to doing mental arithmetic under time pressure while the increase following the
funny film was similar to that seen with aerobic exercise.
Arterial tone is regulated by the endothelial cells that line the inner walls of these vessels. It
has long been known that anger, hostility, anxiety, depression and other stressors cause
vasoconstriction, which may partially explain why they increase risk for heart disease. This
study suggests that laughter could have the opposite effect. The same research group had
previously given 150 patients with coronary disease and 150 healthy age-matched controls a
questionnaire designed to determine their sense of humor and whether they would react to
absurd situations with either laughter or irritation. The results revealed that the heart disease
patients were 40 percent less likely to see such situations as funny.
As emphasized in a recent Newsletter,
laughter is the shock absorber that
softens the blows of and blunts the
harmful effects of stress on health and
life. As also noted in prior Newsletters,
"He who laughs, lasts", and "You
don't stop laughing because you
grow old, you grow old because you
stop laughing."
Laughing may
promote longevity not only because it
helps to prevent cardiovascular disease
and diabetes, but also because it improves
immune system function, lowers blood pressure and stress hormone levels. Numerous other
studies also show that optimistic, happy people with a good sense of humor live longer than
their grouchy counterparts.
References: Miller M, Mangano C, Park et al. Impact of cinematic viewing on endothelial function.
Heart 2006; 92: 261-262. Why Do Happy People And Optimists Live Longer? Health And Stress
Newsletter. July, 2005. Can Laughter & Humor Help You Live Longer? Health And Stress Newsletter.
November, 2005.
A H A P P Y M A R R I A GE R E DU C E S S T R E S S A N D P R O M O T E S H E A L T H A N D L O N GE V I T Y
As noted in prior Newsletters, the Harvard Study of Adult Development is the longest and
most comprehensive investigation of the aging process ever conducted. Since the 1930's,
researchers have closely followed more than 800 men and women from adolescence to old
age to seek clues about behaviors and activities that are associated with healthy longevity.
Some of the findings surprised George Vaillant, the current director of this project and author
of Aging Well. He had anticipated that "the longevity of your parents, the quality of your
childhood and cholesterol levels would be very influential". They were not. Keeping mentally
active and having lots of friends were much more important. A happy marriage or good
long term relationship at age 50 was a leading indicator of being healthy at age 80
but a low cholesterol level had very little significance.
How can such findings be explained? With respect to cholesterol, Newsletter subscribers are
already aware of mounting evidence that elevated cholesterol, like premature baldness and a
deep earlobe crease, may be associated with a higher incidence of heart attacks, but does not
cause them. Similarly, the cardioprotective benefits of statins are not due to cholesterol
lowering since they are also seen in patients with low LDL and cholesterol. It is much more
likely, that, like low dose aspirin, reduction of inflammation and other activities are
January 2007
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responsible. In addition, numerous studies show that cholesterol lowering is of little
value in reducing mortality in senior citizens and that a low cholesterol is actually
associated with increased death rates and numerous health problems.
But why would a happy marriage or having lots of friends promote
healthy aging? The most likely explanation is that stress can accelerate
the aging process and that having strong social support from friends or
family reduces the harmful effects of stress. Stress can contribute to
illness and premature mortality in many ways, including suppression of
the immune system's ability to ward off infections and certain cancers.
British researchers recently reported that in a study of more than 180
senior citizens who received influenza vaccine, those who said they
were happily married developed higher antibodies and more protection
than others who reported less marital satisfaction. Participants also
completed quetionnaires designed to rate exposure to stressful life
events and those who had experienced a significant bereavement in past 12 months had
poorer antibody responses than controls. A happy marriage or long term relationship also
provides strong emotional support, which is a powerful stress buster.
References: Vaillant GE. AGING WELL: Surprising Guideposts to a Happier Life from the Landmark
Harvard Study of Adult Development. Little, Brown and Co. New York, 2002. Health And Stress
Newsletter, #5, #7 2005, #10 2002, #7 2000, #9 1999.
WHY THE S TRESS OF SPA TS WIT H YOUR SPOUS E CAN MAKE YOU SIC K
AND SHORT EN YOU R LIFE
As noted in a recent Stress Scoop, happily married couples are healthier and live longer,
possibly because they have less stress. Numerous studies show that increased stress is
associated with impaired immune system function that reduces resistance to disease. Medical
students who were severely stressed because of concerns about an impending final exam had
lower than normal antibody responses to Hepatitis-B vaccine. A similar poor response to
influenza vaccine compared to matched controls was seen in those caring for a spouse with
Alzheimer's. Another study showed that such caregivers took about 9 days longer than controls
to completely heal a small biopsy wound because of poor immune responses. They also had
higher levels of Interleukin-6, which disrupts immune system function and increases risk for
heart disease, arthritis, osteoporosis, Type-2 diabetes and possibly certain malignancies. These
changes can persist up to three years after care giving activities cease.
There is little doubt that having to provide constant care to a spouse suffering from
Alzheimer's can cause severe stress that impairs wound healing and increases susceptibility
to disease. Howev er, a recent study showed that even if spouses usually get along
well, the stress caused by a brief argum ent can slow healing of a surgical wound
by as much as a day. Researchers admitted 42 couples who had been married on average
for 12.5 years for two 24-hour visits, separated by two months.
At each visit, all
participants were subjected to a suction blister dev ice that produced eight identical tiny
wounds. During the first visit, all couples completed questionnaires designed to measure
stress levels and then engaged in two 10-minute discussions during which they either
requested or provided social support. The procedure was the same during the second visit
ex cept that the discussions were about areas of disagreement designed to produce
emotional and sometimes hostile responses. Couples who were classified as "high hostile"
took a day longer to heal than others not only after the conflict visit (7 days versus 6) but
also after the social support encounter (6 versus 5). Measurements of specific immune
sy stem components showed differences in the delayed healing group that could explain
these results.
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I f a short spat in a lab can have such effects, one can
only wonder what t he response would be t o a fullfledged fight at hom e last ing hours or days. The
Honey mooner's Ralph Kramden was probably luck y that he
never needed emergency surgery since frequent fights could
significantly delay wound healing and reduce resistance to
infection.
References: Kiecolt-Glaser JK et al. Hostile Marital Interactions, Proinflammatory Cytokine Production,
and Wound Healing. Arch Gen Psychiatry. 2005;62:1377-1384. BBC News Online 11/08/2005. Health
And Stress Newsletter #7 1999
A N EW SAL IVA TE ST TO MEASUR E STRE SS
Japanese researchers have developed a rapid and relatively inexpensive way to determine
stress levels by what the media have referred to as a "spit test". This label is not as
derogatory as it might seem because this method has a more scientific basis than stress dots,
stress meters and other devices described in a recent Newsletter devoted to this subject.
These merely detect alterations in blood flow or sweat gland activity due to stimulation of the
sympathetic nervous system and the secretion of adrenalin and similar catecholamine
hormones. In addition, fingertip temperatures or galvanic skin responses used to assess
these changes can be influenced by many factors other than stress. Measuring blood levels of
these and other stress-related hormones is much more accurate but not practical or
convenient because blood tests are expensive and can be difficult to obtain. Determining
salivary concentrations of some of these hormones seems to be a very satisfactory alternative
that has been used by researchers for over two decades since there is a close correlation with
blood test results. This non-invasive approach also avoids the stress often associated with
obtaining blood that can affect the results.
Kits, such as the one on the left, are readily available that
instruct consumers how to collect saliva and mail it to a
laboratory for testing. The cost is under $60.00 and an
analysis of the results is returned in less than a week. DHEA
levels start to steadily decline after age 25 so the results have
to be corrected for age. Some laboratories also measure
salivary concentrations of male and female hormones as an
indicator of biological aging since these can drop up to 8090% from youthful peaks.
However, these salivary
measurements do not correlate as well with their blood levels
compared to cortisol and DHEA
Cortisol and DHEA (dehydroepiandrosterone), are the steroid hormones that are most affected
by stress and measuring their concentrations in saliva has become a particularly popular way
to determine stress levels. Cortisol is increased and DHEA is greatly reduced during stress
and seem to balance one another since they have opposite effects on protein, carbohydrate
and fat metabolism, immune system function and blood pressure. The secretion of these
steroid hormones is regulated by the hypothalamic-pituitary-adrenal axis rather than
stimulation of the sympathetic nervous system and the secretion of catecholamine hormones
that produce "fight or flight" responses. Catecholamines are protein hormones that are very
difficult to measure accurately in saliva in contrast to steroids like cortisol and DHEA. This
January 2007
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obstacle has been overcome by determining the concentration of a chemical called alphaamylase that is produced in response to sympathetic stimulation of the salivary glands. These
results correlate with blood catecholamine levels and can be used as a substitute since the
degree to which they rise during stress corresponds very well with the increase in blood levels
of catecholamines but not cortisol. This makes it feasible to assess both aspects of hormonal
responses to stress by measuring cortisol, DHEA and alpha-amylase concentrations from the
same saliva specimen. Some companies like Salimetrics provide assay kits to do this for
research studies only. Collection is complicated and requires abstaining from cigarettes, coffee
and other beverages containing caffeine, duration of time from your last meal must be noted,
calibrated pipettes are needed and all specimens must be kept frozen prior to submission. In
addition, these test kits are fairly expensive and are not likely to appeal to most consumers.
Japanese researchers have recently developed a method to measure salivary alpha-amylase
that is much more convenient and much less costly. The Cocoro Meter is a hand held device
weighing about a quarter of a pound that comes in four colors, sells for around $165 and comes
with 20 strips. Packs of 20 strips are under $20 so that each additional test costs less than a
dollar. As illustrated below, the strip is moistened with some saliva and inserted into the
device, which displays the results in less than a minute as one of four levels of stress. While
not as accurate as blood tests, this approach seems much superior to stress dots, GSR devices
and similar products that claim to measure sympathetic nervous system responses to stress.
Nipro, a Japanese medical supply company offers
the Cocoro Meter to measure stress based on
salivary alpha-amy lase levels. You simply moisten a
special strip with some saliva and put it into the
machine. Results are display ed as numbers
accompanied by stick figure icons portray ing four
different levels of stress. This happy and smiling
young lady registered a relaxed reading of 20. An
obviously very harried and tense executive had a
score of 80 that was four times higher.
Reference: www.japantoday.com/e/?content=product&id=977&page=2
STR ESS, C ORTISO L AND ABDOMI NAL FA T
Hundreds of millions of dollars have been spent on worthless supplements that claim to
promote weight loss by reducing stress and/or cortisol. Consumers can be easily confused
since advertisements cite reliable references that confirm and explain how increased stress or
cortisol can increase abdominal fat deposits.
For example, Cushing's syndrome is
characterized by a persistent increase in cortisol levels and abdominal obesity. But when the
cause of the elevated cortisol is removed, the excess abdominal fat deposits also disappear.
Chronically stressed primates that have increased cortisol also develop abdominal obesity and
laboratory studies confirm a clear correlation between cortisol levels and the deposition of
deep abdominal fat. A study of stressed out middle-aged Swedish men similarly showed that
those with the highest cortisol levels also had the biggest beer bellies.
Stress can also contribute to "middle aged spread" because many such individuals find that
chocolates, cookies candies, chips and other high fat, high carbohydrate foods relieve their
anxiety. Male and female hormones normally protect against the deposition of abdominal fat
but their levels start to decline after age 40. Most incoming college freshman put on extra
pounds their first year, and as noted in prior Newsletters, this so-called "Freshman 15" is also
due to stress. One study showed that a sample of university women gained weight 36 times
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faster than aged matched controls that did not attend college. In addition to being unsightly,
stress induced abdominal fat secretes large amounts of inflammatory molecules that
contribute to diabetes, insulin resistance and heart attacks. How many extra pounds you are
carrying around may not be as important as where that excess weight is located. People with
apple shaped figures are more susceptible to these disorders as well as certain cancers
compared to those with pear shapes who are just as overweight due to fatty hips and
buttocks. In fact, there is good evidence that increased fat in these locations may be
associated with a decreased risk for coronary disease and atherosclerosis.
Since abdominal fat also tends to increase cortisol levels,
this can lead to a vicious and unhealthy cycle, especially in
women. There is little doubt that increased stress and/or
cortisol can cause increased abdominal fat and weight
gain. However, there is absolutely no proof that any
nutritional supplement reduces stress, cortisol or the
deposition of abdominal fat.
The problem is that
consumers are confused because studies in respected
medical journals such as those noted below are often cited
to provide scientific support, even though they have
nothing to do with these products.
References:
Health and Stress Newsletter #6 2000, # 5 2003, #5 2004. Eppel ES. McEwen B,
Seeman T, et al. Stress and Body Shape: Stress-Induced Cortisol Secretion Is Consistently Greater
Among Women With Central Fat. Psychosom Med, 2000;62:623-632. Yong Q. Takahashi N. Hileman
SM, et al. Adiponectin Acts in the Brain to Decrease Body Weight. Nat Med 2004; 10(5):524-529.
DOES STRESS REDUCTION BENEFIT PATIENTS AT HIGH RISK FOR HEART ATTACKS?
Several studies have confirmed the cardioprotective benefits of stress reduction in patients at
increased risk for future coronary events. The Congressional Prevention Coalition on Stress
Prevention reported that cardiac patients who learn to manage stress reduce their risk of
having another heart attack or heart problem by 74%, suggesting that stress
management is even more effective than exercise in preventing recurrent heart disease.
In one study, researchers took 107 patients with coronary heart disease and put them on
either a four-month stress reduction program, a four-month exercise regimen or allowed them
to receive usual heart care from their personal physicians. Over the next five years, only
three of the 33 people given stress management suffered cardiac events, defined as a heart
attack or heart surgery such as a bypass or angioplasty. Seven of 34 people in the exercise
group suffered such events, as did 12 of the 40 patients receiving typical care. Those in the
stress management program were 74 percent less likely to have additional heart problems
than those who received only routine medical care.
Stress management training consisted of 16 small-group weekly sessions that provided
participants with ways to control negative emotions and thoughts and other stress reduction
techniques. Patients who received stress management training had lower hospitalization and
physician's bills with average costs $5,998 compared to $10,338 for those who received usual
care. These findings are of particular interest since none of the patients entered the study
"complaining of stress", suggesting that any patient with heart disease can benefit from stress
reduction. Ironically, only about 10 to 20 percent of heart patients even wind up in
rehabilitation programs since, although it has proven to be cost effective, insurance is often
an issue. Doctors also say it is surprisingly hard to convince patients that they've got a stress
problem, even after they have had a heart attack.
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References: Hagelin J. "Stress Prevention: Its Impact on Health and Medical Savings", The
Congressional Prevention Coalition on Stress Prevention. June 24, 1998. Blumenthal JA, Babyak M, Wei
J et al. Usefulness of psychosocial treatment of mental stress-induced myocardial ischemia in men.
American Journal of Cardiology January 15, 2002;89:164-168, Vogel JHK, Bolling SF, Costello RB et al.
Integrating Complementary Medicine Into Cardiovascular Medicine J Am Coll Cardiol 2005; 46:184-221.
ANXIETY I NCREAS ES RIS K FOR RECURRENT CORONARY COMPL ICATIONS
German researchers report that heart attack patients who have high levels of anxiety are at
increased risk for subsequent coronary events including heart attacks and death. Physical
examinations and psychosocial assessments were conducted on 76 patients one week and 31
months after a myocardial infarction. During this period, 24 patients required some type of
revascular procedure or suffered a cardiovascular death. A review of the records revealed that
this group had significantly higher anxiety levels than control patients who did not experience
these complications. In addition, the higher the level of anxiety the earlier complications
tended to occur during the convalescent period. Conversely, low anxiety levels were much
more common in patients who had no further coronary symptoms (77% vs. 54%).
Several studies have shown that hostility, depression and lack of social
support are risk factors for poor prognosis following a heart attack but
few studies have examined the role of anxiety. It had previously been
suggested that anxiety might actually have a favorable influence by
encouraging the adoption of a healthier lifesty le. However, this study
reported,
"Anxious patients tended to continue smok ing, whereas
less anxious patients were more lik ely to giv e up smoking during the
follow-up period." In addition to high anxiety levels, being female,
elderly, living without a partner or having diabetes at the onset of the study were also
associated with an increased risk of a recurrent coronary event.
Reference: Benninghovena D, Kadkub A, et al. Influence of Anxiety on the Course of Heart Disease
after Acute Myocardial Infarction - Risk Factor or Protective Function? Psychotherapy and
Psychosomatics 2006; 75: 56-61.
It is our hope that as this library of Stress Scoops and Bulletins grows, it may encourage
viewers to sign up for Membership, which also provides a subscription to our monthly
Newsletter and other benefits. Many Stress Scoops reference previous issues of Health and
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Copyright©2007 by the American Institute of Stress. All rights reserved.
Health and Stress
The Newsletter of
The American Institute of Stress
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ISSN # 1089-148X
Paul J. Rosch, M.D., F.A.C.P.
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